TL;DR: Build the revenue cycle before you open: NPI first, then CAQH, then Medicare, Medicaid, and commercial credentialing in parallel, then your fee schedule, clearinghouse, and a documented billing workflow. Credentialing takes 60–120+ days, so expect a 90-to-120-day gap before first payments and hold four to six months of operating capital.
What comes first?
NPI setup comes first. Apply for your National Provider Identifier through the NPPES website. Link it to your practice address and the correct taxonomy code for physical therapy.
When do you set up CAQH?
Next, create or update your CAQH profile. Complete every section and attest. Most commercial payers pull data directly from CAQH. Re-attest every 120 days to keep the profile active.
How long does payer credentialing take?
Payer credentialing follows. Submit applications to Medicare, Medicaid, and your top commercial payers in parallel. Commercial timelines average 60 to 120 days. Medicaid can take longer by state. Medicare Part B enrollment often allows retroactive billing up to 30 days in some cases.
How do you set your fee schedule?
Set your fee schedule before you see patients. Base it on Medicare rates plus a reasonable markup for commercial payers. Load the schedule into your practice management system.
What does the clearinghouse need to support?
Choose and contract with a clearinghouse. Test claim submission and eligibility verification before opening day. Confirm the clearinghouse supports the 8-minute rule edits and modifier requirements common in therapy billing.
Who does what in your billing workflow?
Build your billing workflow on paper first. Define who verifies insurance, who obtains authorizations, who posts payments, and who follows up on denials. Document each step.
How much operating capital do you need?
The 90-to-120-day credentialing gap means you will likely see patients for three to four months before the first payments arrive. Maintain adequate operating capital during this period.
Cash flow planning includes payroll, rent, malpractice insurance, and software subscriptions. Many new practices secure a line of credit sized for four to six months of expenses.
Start credentialing as soon as you secure your location. Do not wait until the build-out is complete. The same timeline applies when you add new therapists later.
Additional guidance appears in our credentialing & enrollment and revenue cycle management service overviews.
Get a free revenue cycle assessment
Related reading